How to treat child ear pain

Ear Pain in Children | CS Mott Children's Hospital

Ear pain (otalgia) can be a common reason children visit a physician. There are several causes of ear pain, including teething, sore throat, ear infection, or blocked Eustachian tubes.

Otitis media with effusion (Fluid behind eardrum)

Otitis media with effusion occurs when the Eustachian tube that connects the middle ear to the back of the nose becomes blocked. This allows fluid to collect behind the eardrum.

Since there is no infection, antibiotics are not beneficial. Treatment is aimed at symptomatic control: acetaminophen or ibuprofen as needed for pain relief. You can also use warm compresses as needed.

Otitis media with effusion generally self-resolves within 3 months.

Temporary mild hearing loss can be associated with otitis media with effusion. Strategies to help with hearing loss, if present, include:

Speak directly to your child in a louder voice than normal; make good eye contact and use gestures.
Reduce background noise when talking to affected individual (lower volume of TV and radio)

If fluid persists longer than 3 months or hearing loss is a concern, your child may be referred to ENT (Ear, Nose and Throat specialist/Otolaryngologist) for further evaluation. The ENT may discuss tympanostomy tubes (ear tubes), which help drain the fluid in the ear.

Ear infection

When the Eustachian tube that connects the middle ear to the back of the nose becomes blocked, and fluid collects in the middle ear space, viruses or bacteria can sometimes grow in the fluid and cause pain (acute otitis media).

Commonly, these ear infections may occur after or during a viral upper respiratory infection. Otitis media is more common in the winter, and occurs more frequently in children who attend daycare (related to the increased number of viral URIs experienced by these children). Otitis media does not occur after getting water in the ear.

Antibiotics are used for some patients with an ear infection. Since ear infections are not always caused by bacteria, antibiotics are not always needed.

Strategies to prevent ear infections include:

Keep your child’s vaccinations up to date, especially pneumococcal and influenza vaccinations
Avoid exposure to second-hand smoke
Breastfeed your child exclusively for the first 6 months of life
Avoid bottle propping in babies

If a child has repeated episodes of acute otitis media (3 episodes in 6 months or 4 episodes in 1 year), the child may be referred to ENT (Ear, Nose and Throat specialist/Otolaryngologist) for evaluation for tympanostomy tubes (ear tubes) to help the fluid drain.

Swimmer’s ear

Swimmer's ear (otitis externa) occurs when there is an infection present in the external ear canal. This can occur if the skin in the ear canal becomes irritated or scratched and then develops an infection.

Topical antibiotic drops are used in the treatment of swimmer’s ear. Ibuprofen or acetaminophen can be used to control pain.

For patients with recurrent swimmer’s ear, preventative measures include:

Wearing ear plugs when swimming
Drying the ear after swimming with hair dryer on low setting and at least 12 inches from the ear
Use of ear drops containing acetic acid or alcohol after swimming

Eustachian tube dysfunction

The Eustachian tube is a tube that runs from the middle ear to the nasopharynx (back of nose and top of throat). This tube helps to equalize pressure across the tympanic membrane (ear drum), protect the middle ear from infection and help clear middle ear secretions.

Symptoms of Eustachian tube dysfunction include ear pain, ear fullness, decreased hearing, tinnitus or popping/cracking in the ear.

Treatment involves treating the underlying cause of the Eustachian tube dysfunction:

Treat any underlying allergic rhinitis, rhinosinusitis, laryngopharyngeal reflux, GERD
Eliminate exposure to second-hand smoke

Temporomandibular joint disorders

Problems with the hinge that connects your jaw to your skull, the temporomandibular joint, can cause referred ear pain. Additional symptoms of temporomandibular joint disorder can include jaw or facial pain, headache, pain with chewing or opening mouth.

Temporomandibular joint disorders are more common in children over age 10 years.

Treatment includes patient education, avoiding triggers, jaw exercises, use of an occlusion splint if grinding teeth is an issue and use of anti-inflammatory pain medications.

Other causes of ear pain

Other less common causes of ear pain include trauma to the ear or ear canal, foreign body in the ear canal, or wax build-up.

Other illnesses that can cause referred ear pain include teething, parotitis, sinusitis, pharyngeal infections, lymphadenopathy / lymphadenitis and cervical spine injury.

When should you seek help for ear pain?

Call your physician or seek medical care if:

Ear pain is worsening, persistent or not controlled with supportive care measures
There is blood or pus draining from the ear canal
The area around the ear starts to swell or become red
Your child gets a new or higher fever

Caring for Ear Pain

Ear pain may be worse when lying down; so try to have child sit or sleep with head elevated.

Warm compresses may help ease ear discomfort. (However, take care not to burn the skin).

Acetaminophen or ibuprofen can be used to help discomfort; following instructions on label or given by physician.

Do NOT give aspirin to any person under age 18 years. It has been linked to developing Reye syndrome, an illness that causes swelling in the brain and liver.

Do not insert anything into the ear (including Q-tips). It is ok to clean the outside of the ear with a warm washcloth.

Written/reviewed by Lauren Reed, MD

Updated February 2020

Earache

Is this your child's symptom?

Pain in or around the ear
The older child complains about ear pain
Younger child acts like he did with last ear infection or cries a lot
Not caused by an ear injury

Causes of Earaches

Ear Infection. An infection of the middle ear (space behind the eardrum) is the most common cause. Ear infections can be caused by viruses or bacteria. Usually, a doctor can tell the difference by looking at the eardrum.
Swimmer's Ear. An infection or irritation of the skin that lines the ear canal. Main symptom is itchy ear canal. If the canal becomes infected, it also becomes painful. Mainly occurs in swimmers and in the summer time.
Ear Canal Injury. A cotton swab or fingernail can cause a scrape in the canal.
Ear Canal Abscess. An infection of a hair follicle in the ear canal can be very painful. It looks like a small red bump. Sometimes, it turns into a pimple. It needs to be drained.
Earwax. A big piece of hard earwax can cause mild ear pain. If the wax has been pushed in by cotton swabs, the ear canal can become blocked. This pain will be worse.
Ear Canal Foreign Object. Young children may put small objects in their ear canal. It will cause pain if object is sharp or pushed in very far.
Airplane Ear. If the ear tube is blocked, sudden increases in air pressure can cause the eardrum to stretch. The main symptom is severe ear pain. It usually starts when coming down for a landing. It can also occur during mountain driving.
Pierced Ear Infections. These are common. If not treated early, they can become very painful.
Referred Pain. Ear pain can also be referred from diseases not in the ear. Tonsil infections are a common example. Tooth decay in a back molar can seem like ear pain. Mumps can be reported as ear pain. Reason: the mumps parotid gland is in front of the ear. Jaw pain (TMJ syndrome) can masquerade as ear pain.

Ear Infections: Most Common Cause

Definition. An infection of the middle ear (the space behind the eardrum). Viral ear infections are more common than bacterial ones.
Symptoms. The main symptom is an earache. Younger children will cry, act fussy or have trouble sleeping because of pain. About 50% of children with an ear infection will have a fever.
Diagnosis. A doctor can diagnose a bacterial ear infection by looking at the eardrum. It will be bulging and have pus behind it. For viral ear infections, the eardrum will be red but not bulging.
Age Range. Ear infections peak at age 6 months to 2 years. They are a common problem until age 8. The onset of ear infections is often on day 3 of a cold.
Frequency. 90% of children have at least 1 ear infection. Frequent ear infections occur in 20% of children. Ear infections are the most common bacterial infection of young children.
Complication of Bacterial Ear Infections. In 5% to 10% of children, the eardrum will develop a small tear. This is from the pressure in the middle ear. The ear then drains cloudy fluid or pus. This small hole most often heals over in 2 or 3 days.
Treatment. Bacterial ear infections need an oral antibiotic. Viral ear infections get better on their own. They need pain medicine and supportive care.

When to Call for Earache

Call 911 Now

Not moving or too weak to stand
You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

Severe earache and not improved 2 hours after taking ibuprofen
Pink or red swelling behind the ear
Outer ear is red, swollen and painful
Stiff neck (can't touch chin to the chest)
Walking is not steady
Pointed object was put into the ear canal (such as a pencil, stick, or wire)
Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
Fever over 104° F (40° C)
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

Earache, but none of the symptoms above. Reason: could be an ear infection.
Pus or cloudy discharge from ear canal

Seattle Children's Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Bellevue
Everett
Federal Way
Seattle

Care Advice for Earache

What You Should Know About Earaches:
- Your child may have an ear infection. The only way to be sure is to look at the eardrum.
- It is safe to wait until your doctor's office is open to call. It is not harmful to wait if the pain starts at night.
- Ear pain can usually be controlled with pain medicine.
- Many earaches are caused by a virus and don't need an antibiotic.
- Here is some care advice that should help until you talk with your doctor.
Pain Medicine:
- To help with the pain, give an acetaminophen product (such as Tylenol).
- Another choice is an ibuprofen product (such as Advil).
- Use as needed.
Cold Pack for Pain:
- Put a cold wet washcloth on the outer ear for 20 minutes. This should help the pain until the pain medicine starts to work.
- Note: some children prefer heat for 20 minutes.
- Caution: heat or cold kept on too long could cause a burn or frostbite.
Ear Infection Discharge:
- If pus is draining from the ear, the eardrum probably has a small tear. Usually, this is from an ear infection. Discharge can also occur if your child has ear tubes.
- The pus may be blood-tinged.
- Most often, this heals well after the ear infection is treated.
- Wipe the discharge away as you see it.
- Do not plug the ear canal with cotton. Reason: retained pus can cause an infection of the lining of the ear canal.
Fever Medicine:
- For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
- Another choice is an ibuprofen product (such as Advil).
- Note: fevers less than 102° F (39° C) are important for fighting infections.
- For all fevers: keep your child well hydrated. Give lots of cold fluids.
Return to School:
- Ear infections cannot be spread to others.
- Can return to school or child care when the fever is gone.
Call Your Doctor If:
- Pain becomes severe
- You think your child needs to be seen
- Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 11/20/2022

Last Revised: 01/13/2022

what to do, first aid, how to treat

Most often, earaches begin suddenly - at night, on holidays or during rest, so they take the family by surprise. The problem can be caused by various internal and external factors. Most often, it is not possible to immediately determine the cause of pain in the ear, you have to act intuitively, rely on the help of a doctor or call an ambulance. It is important for parents to understand how to alleviate the condition of the baby. Learn how to competently and without harm to health to help a child if his ear hurts.

What you need to know about ear pain in children

Functions of the human ear	The ear is a complex organ. They allow us not only to hear speech, sounds, but also help us navigate in space, maintain coordination of movements, determine where sounds come from, activate the cerebral cortex and brain centers.
How often do children get otitis media	By the age of 7, 95% of children suffer from acute otitis media at least once (1). More than 50% of cases occur in children under 5 years of age (2).
Otitis in children of the first year of life	Acute otitis media is a common disease in children of the first year of life, and in newborns it occurs 2 times more often than in older infants, and with a higher frequency in boys than in girls. In 31% of cases in newborns and in 26.5% of infants, acute otitis media occurs latently (that is, imperceptibly) (3).
Signs of ear pain in babies	At an early age it is difficult for a child to explain what is bothering him. When the ear hurts, the baby touches, rubs it and even pats it in annoyance. He lies on his side, where he hurts, cannot sleep, cries, is naughty, becomes lethargic and loses his appetite.
What not to do if your child has an earache	To avoid harm, never remove the wax plug with sharp objects or an ear stick. It is forbidden to rinse the ears with large amounts of water with a syringe and use antibiotics without consulting a doctor. If there is a discharge, you can not use ear drops and apply warm compresses to the sore spot.

How to understand that a child's ear hurts

- Recognizing the problem can be difficult, especially if the child is too young to tell his parents what is bothering him. Older children usually report sharp pains themselves. - The easiest way to determine the pain in the baby's ear is to lightly press on the tragus. This is a small cartilaginous protrusion on the outer ear, in front of the pinna. In case of pain, the child will definitely respond, advises Daniil Karpichev, lecturer in medical disciplines at the Cherepovets Medical College. N. M. Amosova .

Why a child may have an earache

Ear pain usually occurs at night, since the horizontal position promotes infection in the Eustachian tube and middle ear cavity. First of all, you need to find out the reason why the child has an earache. Consider the possible options.

Infections and anatomy

Most children experience ear infections at an early age. According to Russian scientists, more than 35% of babies already in the first year of life suffer from acute otitis media 1-2 times, and by the age of 3 years this diagnosis usually appears in the medical records of 71% of children (2).

The causes of the disease are the anatomical features of the location of the Eustachian tube. In babies, it is wide and short, so the infection easily gets from the nasopharynx into the Eustachian tube, and then into the middle ear cavity. In addition, when breastfeeding, milk can be thrown into the Eustachian tube. To avoid this, after feeding, the baby should be held upright for some time.

Foreign body in the ear

While playing, children can put buttons, small sweets, parts of the designer, beads, seeds, peas, pieces of cotton wool into the external auditory meatus. In more rare cases, ENT doctors find insects in the child's ear: ticks, cockroaches, bedbugs and flies. It most often occurs between the ages of 2 and 5.

Foreign bodies cause discomfort and pain. With a long stay in the ear canal, complications can develop. It is not worth taking out a foreign body on your own - even if it is visible. It is better to trust a specialist who has everything necessary for the procedure.

Trauma to the ear or pinna

Mechanical trauma to the ear is a common problem in children. A child may experience pain after a burn or an insect bite, such as a bee. During sports training and games, with a strong blow, the ear may swell, sometimes blood appears from the ear canal. If this happens, close the ear canal with a sterile bandage or cotton, apply a bandage and go with the child to the emergency room.

Hypothermia

Hypothermia during windy weather can sometimes lead to ear pain. The people say about it "blown away".

Water in the ear

It happens that when swimming in a pool, river, sea or in the shower, water gets into the ear. If moisture has reached the middle ear, the child feels backache and congestion. Older children can be taught to hop on one or two legs by tilting their head towards the blocked ear. With kids who still do not know how to jump or do not understand how to do it, they act differently. An adult puts his hand to the blocked ear of the child, presses it with force, and then abruptly removes it. The air flow destroys the water plug.

Large buildup of earwax

Wax plug is a common problem in children. The fact that it exists is indicated by the absence of reactions to sounds, tinnitus, a feeling of congestion, coughing and other signs. The child may often rub his ear. It is better to solve the problem not at home, but with the help of a doctor.

Side effect of an infectious disease

Angina, laryngitis, pharyngitis, SARS can lead to complications in the form of ear pain. As a rule, discomfort disappears after the child gets rid of the underlying disease.

Ear canal abscess

The ear canals, like the skin in general, have their own hair follicles. If for some reason the hair follicle becomes inflamed, ear pain appears.

What to do if your child's ear hurts: first aid at home

First aid can be provided at home, but then the child must be shown to a pediatrician or ENT doctor. After the examination, the doctor will give recommendations and prescribe the necessary drugs. Further treatment can take place on an outpatient basis, and with the development of complications of otitis media - in a hospital. If you called an ambulance, you should not give medicines and carry out any manipulations on your own. The doctor will examine the child, ascertain the symptoms and give recommendations.

If there is a temperature

If the temperature rises to 38°C or more, antipyretics based on ibuprofen or paracetamol can be given. These medicines also relieve ear pain. With severe unbearable pain, drops help (for example, Otipax, Otinum), but they can be instilled when there is no purulent discharge.

If there is no temperature

Seat the child. In an upright position, the mucus will more easily come out of the Eustachian tube, and the pain in the ear will decrease. If the nose is blocked, free it from mucus and drip vasoconstrictor drops.

In the absence of purulent compartments, you can apply an alcohol compress to the ear: moisten gauze with alcohol, wrap around the ear, cover with wax paper and a layer of cotton. Wrap a scarf or scarf on top and leave for several hours.

Prevention of ear pain in children

Physicians cite regular viral infections, nearby adults smoking, infections in day care centers and family history of acute otitis media as risk factors (2). What can be done to avoid ear pain in children? Protect babies from hypothermia, infectious diseases, strengthen immunity. Kids need to be taught to play carefully with small objects, to explain that pencils, brushes, toothpicks, and other objects should not be put into their ears - anything that can cause injury to the auricles and eardrums. Do not let children swim without a rubber cap.

These are the basic rules for preventing injuries and otitis media. When it comes to health, it's better to be over-indulgent than under-indulgent.

Expert comments

Daniil Karpichev, Lecturer in Medical Sciences, Cherepovets Medical College. NM Amosova:

— Pain in the ears is a fairly common symptom, most often occurs with acute respiratory viral infections (rhinitis, nasopharyngitis). Pain in the ears against the background of high temperature may indicate the onset of the inflammatory process - otitis media. There is otitis externa, internal, with purulent discharge from the ear and without it. With timely treatment, the prognosis of the course of the disease is favorable. If it is not possible to see a doctor right now and there is no discharge from the ear, you can use drops with anti-inflammatory and analgesic effects. If the temperature persists for more than 4 days with pain in the ear, you may need antibiotic therapy, so you should not postpone visiting a specialist.

Elizaveta Gammel, pediatrician, functional diagnostician:

- The outer ear is a canal that runs from the auricle to the entrance to the middle ear, tightly closed by the tympanic membrane. Inflammation in the outer ear, called "otitis externa", can occur after a microtrauma, such as a scratch, or after hypothermia. This happens after swimming in the pool, or if you jump out without a hat on a cold street. The pain in this case is not very pronounced, but noticeable. The ear itches unbearably, and if you touch it or, moreover, look inside, it causes a sharp increase in pain. Sometimes there is discharge from the ear.

The middle ear is an isolated chamber. From the "street" it is closed by a thin eardrum. However, to maintain optimal pressure inside, the middle ear cavity is connected to the nasal cavity and pharynx by a thin tube - the Eustachian tube. When the pressure in the middle ear changes, the person feels stuffy in the ears and hearing is reduced. This happens, for example, when taking off in an airplane, going up in a high-speed elevator, or when the atmospheric pressure changes before it rains.

In inflammation of the middle ear, the tympanic cavity is filled with mucus - exudate. The pressure in the tympanic cavity rises, affecting the ear nerve. The pain is unbearable, it is comparable to the pain experienced by a woman during childbirth. On examination, the specialist will see redness of the eardrum, its bulging, and sometimes rupture. He will also determine that behind the eardrum is just exudate or pus. Pain in otitis media is throbbing, sharp, aggravated by any sound.

There is also such a thing as tubo-otitis. This is when, due to swelling in the nose during a runny nose, the lower part of the Eustachian tube is blocked, and a vacuum is created in the middle ear. In this case, the tympanic membrane is retracted. With tubo-otitis, a person feels a slight itch in the ear or as if something is tickling inside. There is no pain in this.

Lidocaine drops and pain relievers based on ibuprofen or paracetamol are used for any ear pain. The child should immediately be shown to a doctor: a pediatrician who owns otoscopy, or an ENT doctor, since the treatment of different types of otitis media depends on the cause.

Otitis in a child: symptoms, first aid

Children often get ARVI. Most infections pass quickly due to the protective functions of the baby's body, proper care, as well as adequate treatment. However, in some cases SARS occur with complications. Otitis media is one of the most common complications of viral respiratory infections in children. This is facilitated by the features of the anatomical structure in young children - a short, wide and more horizontal auditory tube, which connects the nasopharyngeal cavity and the middle ear, which means that the infection can easily penetrate from the nasopharynx. Otitis can cause infectious diseases such as measles, rubella. Sometimes it happens that frequent profuse regurgitation of the baby becomes the cause of otitis media, while the remnants of food can enter the middle ear through the auditory tube and cause inflammation. The cause of repeated otitis often becomes adenoiditis.

What is otitis media

In young children, the onset is usually sudden, with a sharp pain in the ear. Older children may complain of hearing loss. Pain in the ear may be accompanied by a rise in temperature up to 40 ⁰ C. It is more difficult to suspect otitis in infants, because. they can't complain about the pain. Parents may suspect otitis in a baby by the following signs:

Crying, crying.
Anxiety, moodiness, sleep disturbances, refusal of the breast.
Attempts to finger the ear, rolling the head on the pillow.
Increased screaming and crying on pressure on the tragus of the ear.

Discharge from the ear is another sign of otitis media. They can be serous or purulent, have an admixture of blood. Discharge from the ears with otitis occurs as a result of perforation (rupture) of the eardrum. Lack of treatment for this condition can lead to a persistent hearing loss in a baby, which once again confirms the need for immediate medical attention at the first sign of otitis media.

Treatment of otitis media and first aid

Treatment of otitis media must be prescribed by a physician. No need to get involved in treatment without an examination by an otorhinolaryngologist. Usually otitis is treated with antibiotics, the course of treatment is 7-10 days. The toilet of the external auditory canal, the restoration of the patency of the Eustachian tube and the normalization of pressure in the tympanic cavity, local and general anti-inflammatory therapy, antibiotic therapy are among the main areas of treatment for otitis media. In some cases, the patient is shown paracentesis - a therapeutic puncture of the eardrum. Again, please note that only a doctor can prescribe specific drugs for your child.

Help at home:

The use of vasoconstrictor nasal drops is an essential component of the treatment of otitis media. These drugs restore the patency of the auditory tube, which helps to normalize the pressure in the tympanic cavity.

Put vasoconstrictor drops in your child's nose. Choose a drug that you have already taken.
For fever and/or severe pain, give your child an age-appropriate antipyretic. Paracetamol and ibuprofen preparations effectively relieve pain in otitis media.
Dry heat is indicated for otitis media. It is enough to put on a hat or a scarf that covers the ears. Do not use hot compresses or heating pads unless directed by a doctor. Remember! Any thermal procedures are CONTRAINDICATED for suppuration and elevated temperature.
If purulent or serous fluid is discharged from the ear, remove it with a cotton swab dipped in a 3% hydrogen peroxide solution.

Prophylaxis

It is necessary to treat the nose, nasopharynx and pharynx in time in children. This is especially true for enlarged adenoids.

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